title: [Prognostic pulmonary and thoracic findings in patients with unstable injuries of the thoracic spine].
abstract: BACKGROUND
  Instable fractures of the thoracic spine imply a substantial trauma to the chest. The aim of this study was to undertake a systematic analysis of the prognostic impact of CT findings of the chest wall, mediastinum, lungs, and pleural space on the mortality rate.
  
  
  METHODS
  All multiple injury patients with instable fractures of the thoracic spine and initial CT scans treated in our clinic from April 2004 to May 2007 were eligible. The following variables were evaluated for their prognostic power: injury to the lungs (pneumothorax, effusion, lung contusions/lacerations, atelectasis), mediastinum (vessel dissection/rupture, bleeding, diaphragmatic rupture), chest wall (bruises, soft tissue emphysema, rib fractures), and need for pre-diagnostic tube thoracostomy. The significance level was set to P = 0.05.
  
  
  METHODS
  Of a total of 33 patients (mean age: 43.5 ± 20.1 years [range 14 - 83 years]; 25-male [76 %]), seven patients (21 %) died with women being significantly more affected (P < 0.001). Mortality rate was not influenced by patient age.
  
  
  RESULTS
  Non-survivors displayed significantly higher median lung contusion score values compared to survivors (4.0 [0 - 12] versus 1.0 [0 - 10]; P = 0.016). The following variables revealed a significant association with the mortality rate: chest wall bruises with soft tissue emphysema > 90 ° of the thoracic circumference (sensitivity [SE]: 43 %, specificity [SP]: 100 %, positive predictive value [PPV]: 100 %, negative predictive value [NPV]: 87 %, overall accuracy [OA]: 88 %; P = 0.006), rib fractures (SE: 71 %, SP: 81 %, PPW: 50 %, NPW: 91 %, OA: 79 %; P = 0.016), mediastinal haematoma (SE: 71 %, SP: 77 %, PPW: 45 %, NPW: 91 %, OA: 76 %; P = 0.027), and bilateral pneumothoraces (SE: 29 %, SP: 100 %, PPW: 100 %, NPW: 84 %, OA: 85 %; P = 0.040).
  
  
  CONCLUSIONS
  Multiply injured patients with instable fractures of the thoracic spine display CT findings indicative of non-survival. Image acquisition and interpretation focusing solely on the spine should be avoided to ensure the detection of prognostic injury patterns to the lungs.
authors.affiliation: Institut für Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, Berufgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-Universität Bochum.
authors.forename: S P
authors.initials: SP
authors.lastname: Lemburg
authors.forename: T M
authors.initials: TM
authors.lastname: Frangen
authors.forename: H
authors.initials: H
authors.lastname: Knoop
authors.forename: V
authors.initials: V
authors.lastname: Nicolas
authors.forename: C M
authors.initials: CM
authors.lastname: Heyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D055370:Lung Injury / Q000000981:diagnostic imaging / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000401:mortality*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D055815:Young Adult